Mosaicplasty: long-term follow-up.

The successful treatment of chondral and osteochondral defects of the weightbearing surfaces is a challenge for orthopaedic surgeons. Autologous osteochondral transplantation is one method that can be used to create a hyaline or hyaline-like repair in the defect area. Ten years of clinical experience with autologous osteochondral mosaicplasty are described. Clinical scores, imaging techniques, arthroscopy, histological examination of biopsy samples, and cartilage stiffness measurements were used to evaluate the clinical outcomes and quality of the transplanted cartilage in a total of 831 patients who underwent mosaicplasty. According to our investigations, good-to-excellent results were achieved in 92% of the patients treated with femoral condylar implantations, in 87% of those treated with tibial resurfacing, in 79% of those treated with patellar and/or trochlear mosaicplasties, and in 94% of those treated with talarprocedures. Long-term donor-site disturbances, which were assessed using the Bandi score, showed that patients had 3% morbidity after mosaicplasty. Sixty-nine of 83 patients who were followed arthroscopically showed congruent gliding surfaces, histological evidence of the survival of the transplanted hyaline cartilage, and fibrocartilage filling of the donor sites. Four deep infections and 36 painful postoperative hemarthroses were experienced as complications arising from the surgical procedures. On the basis of both these promising results and also those of other similar studies, autologous osteochondral mosaicplasty would appears to be an alternative for the treatment of small and medium-sized focal chondral and osteochondral defects of the weightbearing surfaces of the knee and other weightbearing synovial joints.

[1]  P. L. Ripoll,et al.  Trasplantes osteocondrales en mosaico: estudio de los resultados mediante RMN y segunda artroscopia , 1999 .

[2]  S. Takai,et al.  The transplantation of an autogeneic osteochondral fragment for osteochondritis dissecans of the knee. , 1985, Clinical orthopaedics and related research.

[3]  M. Campanacci,et al.  Autogenous patella as replacement for a resected femoral or tibial condyle. A report on 19 cases. , 1985, The Journal of bone and joint surgery. British volume.

[4]  K. Messner,et al.  Synthetic implants for the repair of osteochondral defects of the medial femoral condyle: a biomechanical and histological evaluation in the rabbit knee. , 1993, Biomaterials.

[5]  L. Hangody,et al.  Mosaicplasty for the treatment of articular cartilage defects: application in clinical practice. , 1998, Orthopedics.

[6]  C. Ohlsson,et al.  Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. , 1994, The New England journal of medicine.

[7]  H. Stedtfeld,et al.  [Experiences with arthroscopic therapy of chondral and osteochondral defects of the knee joint with OATS (Osteochondral Autograft Transfer System)]. , 2000, Zentralblatt fur Chirurgie.

[8]  S W O'Driscoll,et al.  Durability of regenerated articular cartilage produced by free autogenous periosteal grafts in major full-thickness defects in joint surfaces under the influence of continuous passive motion. A follow-up report at one year. , 1988, The Journal of bone and joint surgery. American volume.

[9]  L. Hangody,et al.  Mosaicplasty for the Treatment of Osteochondritis Dissecans of the Talus: Two to Seven Year Results in 36 Patients , 2001, Foot & ankle international.

[10]  L. Hangody,et al.  [New possibilities in the management of severe circumscribed cartilage damage in the knee]. , 1994, Magyar traumatologia, ortopedia, kezsebeszet, plasztikai sebeszet.

[11]  A. Gross,et al.  The allotransplantation of partial joints in the treatment of osteoarthritis of the knee. , 1975, Clinical orthopaedics and related research.

[12]  J. Garrett.  Treatment of osteochondral defects of the distal femur with fresh osteochondral allografts: a preliminary report. , 1986, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[13]  Z. Lukacs,et al.  The surgical technique and the age of the horse both influence the outcome of mosaicplasty in a cadaver equine stifle model , 2001 .

[14]  W. Akeson,et al.  The Repair of Large Osteochondral Defects An Experimental Study in Horses , 1972, Clinical orthopaedics and related research.

[15]  A. Burkart,et al.  [Autologous osteochondral transplantation on various joints]. , 1999, Der Orthopade.

[16]  H J Mankin,et al.  Articular cartilage repair and transplantation. , 1998, Arthritis and rheumatism.

[17]  M. Marcacci,et al.  Use of autologous grafts for reconstruction of osteochondral defects of the knee. , 1999, Orthopedics.

[18]  R J Minns,et al.  Biological response to woven carbon fibre pads in the knee. A clinical and experimental study. , 1990, The Journal of bone and joint surgery. British volume.

[19]  L. Hangody,et al.  Mosaicplasty for the Treatment of Articular Defects of the Knee and Ankle , 2001, Clinical orthopaedics and related research.

[20]  A. Miniaci,et al.  Treatment of unstable osteochondritis dissecans lesions of the knee using autogenous osteochondral grafts (mosaicplasty). , 1999, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[21]  T. Wickiewicz,et al.  Contact Pressures at Osteochondral Donor Sites in the Knee , 1998, The American journal of sports medicine.

[22]  S. Santavirta,et al.  Periosteal and perichondral grafting in reconstructive surgery. , 1994, Clinical orthopaedics and related research.

[23]  J. Lysholm,et al.  Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale , 1982, The American journal of sports medicine.

[24]  K.,et al.  Perichondral grafting for cartilage lesions of the knee. , 1990, The Journal of bone and joint surgery. British volume.

[25]  S. Woo,et al.  Rib perichondrial autografts in full-thickness articular cartilage defects in rabbits. , 1992, Clinical orthopaedics and related research.

[26]  K. R. Stone,et al.  Surgical technique for articular cartilage transplantation to full-thickness cartilage defects in the knee joint , 1997 .

[27]  W. Lierse,et al.  Autologous rib perichondrial grafts in experimentally induced osteochondral lesions in the sheep-knee joint: Morphological results , 2005, Virchows Archiv A.

[28]  A. Gross,et al.  The long-term success of fresh, small fragment osteochondral allografts used for intraarticular post-traumatic defects in the knee joint. , 1992, Orthopedics.

[29]  L. Hangody,et al.  Autogenous osteochondral graft technique for replacing knee cartilage defects in dogs , 1997 .

[30]  E. Solheim,et al.  [Mosaicplasty in articular cartilage injuries of the knee]. , 1999, Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke.

[31]  C. Peham,et al.  Arthroscopic autologous osteochondral mosaicplasty for the treatment of subchondral cystic lesion in the medial femoral condyle in a horse. , 2000, Acta veterinaria Hungarica.

[32]  R. E. Outerbridge,et al.  The use of a lateral patellar autologous graft for the repair of a large osteochondral defect in the knee. , 1995, The Journal of bone and joint surgery. American volume.